MEDICARE: DR. KATRINA LOUISE LUERAS-COLLINS D.D.S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DD2801	NM

General Provider Information

NPI Number	:	1225182710
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATRINA LOUISE LUERAS-COLLINS D.D.S

Provider Business Mailing Address
First Line	:	1000 BLUE HOLE RD
Second Line	:
City	:	SANTA ROSA
State	:	NM
Zip	:	88435-2533
Country	:	US
Telephone Number	:	505-718-6899
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 BLUE HOLE RD
Second Line	:
City	:	SANTA ROSA
State	:	NM
Zip	:	88435-2533
Country	:	US
Telephone Number	:	505-718-6899
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/22/2007
Last Update Date	:	07/08/2007

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Directions to “ DR. KATRINA LOUISE LUERAS-COLLINS D.D.S” Practice Location

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